Health literacy awareness training for healthcare workers: improving knowledge and intentions to use clear communication techniques

Objective

Health literacy is a growing concern as its relationship with health outcomes becomes clearer. Efforts to enhance awareness of patient health literacy in health professional education have focused on physicians, and the objective of this research was to provide an initial assessment of a training session designed for healthcare workers of all kinds.

Methods

Pre- and post-surveys were completed by 166 participants (N = 166) in training sessions designed to improve knowledge of health literacy and instruction in clear communication techniques. Participants provided baseline and post-training assessments of perceived knowledge of health literacy and use of strategies to improve communication with low health literate audiences.

Results

Participants, initially overestimating their own knowledge of health literacy, improved on outcome measures regarding perceived health literacy knowledge. Participants also indicated strong intentions to use clear communication techniques covered in the training.

Conclusion

Results suggest there is an opportunity and need to improve health literacy training for healthcare workers of all kinds. Widespread adoption of health literacy training programs would improve the delivery of healthcare to low health literate patients.

Practice implications

Participants initially overestimated their knowledge of health literacy, suggesting a need to improve initial training and continuing medical education regarding health literacy.     

A course for nurses to handle difficult communication situations. A randomized controlled trial of impact on self-efficacy and performance

Objective

To evaluate the impact of a communication skills course for nurses on how to handle difficult communication situations in their daily work.

Methods

A 7-h course was developed using a construct of “Awareness, Feelings, Listen, Solve” (AFLS). A pedagogy of experiential, learner-centered learning was adopted. The course evaluation used a randomized controlled design with pre- and post-measures of self-efficacy and performance.

Results

Forty-one nurses volunteered and thirty-three nurses completed all assigned parts of the study. On self-assessment, there was significant improvement for self-efficacy (F = 24.43, p < 0.001), but not for emotional awareness. On performance, there was no significant improvement between intervention and control groups (F = 3.46, p = 0.073).

Conclusion

A short course for nurses on handling difficult communication situations achieved significant improvements in self-efficacy but not in performance.

Practice implications

Teaching communication skills in community-based settings is important for the safety and effectiveness of patient care. Sponsoring organizations should weigh trade-offs between feasibility and achievement of measurable improvements in performance. One possible approach is to focus on specific communication skills rather than a full suite of skills.     

Perspectives and expectations for telemedicine opportunities from families of nursing home residents and caregivers in nursing homes

Background

This study assessed current perspectives and expectations for telemedicine by nursing home caregivers and families of nursing home patients in Taipei, Taiwan.

Methods

A total of 116 interviews were conducted with family members (n = 37) and caregivers (n = 79) using an original, four-part questionnaire devised to assess the expectations and concerns related to prospective telemedicine opportunities, including consumer attitude, knowledge of and interest in medicine, concerns and worries about telemedicine, and anticipated benefits of telemedicine.

Results

Statistical significance between the two groups was observed in sex, age, and educational level (all p < 0.001). Most respondents had heard about telemedicine before participation and showed some interest in telemedicine implementation. More than 70.0% of subjects in both groups had perceptions of telemonitoring of patients, notifications of health abnormalities, teleconferencing between physicians and family members, obtaining test/exam results and face-to-face consultation through telenetworks. Both groups hoped for information and education through telemedicine. More caregivers were concerned about increased costs (p = 0.020), poor hardware quality (p < 0.001), poor security, confidentiality, and reliability (p = 0.036), inconvenience to patients (p = 0.006), associated moral and ethical issues (p = 0.006), and uncertainty about responsibility (p = 0.022). The two groups did not differ in expectations concerning benefits of telemedicine. More than 60% of family members or caregivers expected improved efficiency and quality of hospital and nursing home health care, greater rapport between nursing homes and either staff or patients, reduced overall medical costs of caregiving, and reduced staff/caregiver working hours. The acceptable cost was anything up to $15.30 USD per month.

Conclusions

Nursing home caregivers and families of nursing home patients are highly interested in telemedicine; however, they are only willing to pay a slightly higher cost of nursing care for this service. The challenge for the future in this industry is to balance peoples’ demands and telemedicine's associated costs. Results of this study suggest that caregivers and families of nursing home residents favour telemedicine implementation to provide enhanced care coordination in nursing homes when economic circumstances are favourable.     

Relationship of insulin resistance to psychobehavioral characteristics of overweight and obese African American children

Objectives

The objective of this study was to evaluate the relationships of insulin resistance to positive as well as negative dimensions of the child's emotions, behavior and personality (hereafter referred to as “psychobehavioral characteristics”) in a convenience sample of inner-city, overweight and obese, African American children.

Methods

A secondary analysis was performed on a sample of 127 children ages 9-12 yr old who were participating in a community-based, Type 2 diabetes prevention program. Psychobehavioral characteristics of children were assessed using both child and parent ratings derived from the Behavioral Assessment for Children, 2nd edition (BASC-2). Body fatness was evaluated using anthropometric techniques, and insulin resistance (HOMA-IR) was calculated from fasting glucose and insulin concentrations. Hierarchical multiple linear regression models were employed with BASC scales as dependent variables and HOMA-IR as the independent variable of interest.

Results

After adjusting for child age, pubertal stage, gender, family socioeconomic index, and intervention group assignment, child HOMA-IR was related at p < 0.05 to less favorable scores for parent-report of behavioral symptoms and externalizing problems composites, and to content scales for bullying and negative emotionality. Additionally, child HOMA-IR was related at p < 0.01 to less favorable scores for child-report inattention/hyperactivity composite. Body fatness suppressed the unfavorable relationship between HOMA-IR and these and other psychobehavioral characteristics as the degree of significance was higher following adjustment for body fatness in this cohort.

Conclusion

More than one psychobehavioral characteristic were associated with body fatness and insulin resistance in the overweight children of this study. Whether the associations are due to several, or only one, of these psychobehavioral characteristics could not be determined. A much larger and future study will be needed to determine which, if any, of these psychobehavioral characteristics are independently associated with insulin resistance in overweight children.     

Exercise and severe depression: preliminary results of an add-on study

Background

Physical exercise has been extensively researched as a therapeutic option for treatment of major depression.

Methods

In a randomized controlled trial, we analyze the effects of aerobic physical exercise as an add-on strategy for treatment of severe depressed inpatients. The exercise has a “Dose” of 16.5 kcal/kg/week, three times a week during all the hospitalization.

Results

Our preliminary results show that there is no significant difference in scores of Hamilton in the second week between groups (Mean[SD] = 8.2[5.96] × 11.18[5.03], p = 0.192). However, there is a significant reduction in Hamilton scores of patients in exercise group at discharge (Mean[SD] = 5.93[4.46] × 9.45[3.56], p = 0.041). Regarding Quality of Life (QoL), no significant difference were found between groups in the second week in physical domain (Mean[SD] = 56.98[8.96] × 54.54[9.18], p = 0.511) and psychological domain (Mean[SD] = 50.88[13.88] × 42.04[12.42], p = 0.106). However, there is a significant difference in psychological domain (Mean[SD] = 55.88[9.92] v 41.66[13.04], p = 0.004) and a trend but no statistical significance in the physical (Mean[SD] = 58.80[9.14] × 52.12[8.70], p = 0.07) at discharge.

Limitations

Many patients receive different treatment strategies, like ECT (1 patient at exercise group × 3 at control group). Other limitation is the small number of participants included until this moment.

Conclusion

Our preliminary results suggest that physical exercise could be a feasible and effective add-on strategy for treatment of severe depressed inpatients, improving their depressive symptoms and QoL.     

Carotid intima-media thickness is increased in patients with mucopolysaccharidoses

Background

The feasibility of carotid artery intima-media thickness (C-IMT), an established cardiovascular disease marker, as a cardiac risk marker in mucopolysaccharidosis (MPS) patients was explored.

Objectives

To determine if C-IMT is abnormal in MPS versus unaffected controls, and if C-IMT correlates with coronary artery diameter in MPS.

Material and methods

Measurements of C-IMT via neck ultrasound and echocardiographic parameters, including coronary artery diameters, were obtained from MPS and control patients, and compared.

Results

Sixteen MPS subjects (6 MPS I, 6 MPS II, 2 MPS III, 1 MPS VI, 1 MPS VII) and sixteen age, ethnicity, and gender-matched controls were enrolled. Median MPS and control subject ages were 8.3 ± 4.5 and 8.6 ± 4.3 years, respectively (p = 0.73). Mean MPS and control C-IMTs were 0.54 ± 0.070 and 0.48 ± 0.034 mm (p = 0.0029). No differences in left main, left anterior descending, or right coronary artery diameters were seen between MPS and controls. A significant proportion of MPS subjects had mitral insufficiency (14/16; p = 0.0002), aortic insufficiency (10/16; p = 0.0021), and left ventricular dilatation (7/16, p = 0.037) versus controls. C-IMT did not correlate significantly with age, height, weight, coronary measurements, or duration of treatment.

Conclusion

C-IMT in MPS patients is increased compared to matched controls, likely reflective of arterial intima-medial glycosaminoglycan accumulation. MPS subjects demonstrated a high percentage of left-sided valvular insufficiency and ventricular dilatation. Additional studies should be performed in MPS patients to determine if C-IMT correlates with arterial elasticity, biomarkers of vascular dysfunction, and higher risk of cardiovascular events.     

Helping women make choices about mammography screening: An online randomized trial of a decision aid for 40-year-old women

Objective

To evaluate the effect of a decision aid (DA) on women's knowledge of the benefits and harms of screening and on their ability to make an informed decision.

Methods

An online randomized controlled trial among 321 women aged 38-45 years was conducted. Participants were randomized to either immediate or delayed access to the online DA which (i) explained the benefits and harms, (ii) included a values clarification exercise and a worksheet to support decision making. The primary outcome, knowledge of benefits and harms of screening, and secondary outcomes, informed choice (composite of knowledge, values and intention), anxiety and acceptability of the DA were measured using online questionnaires.

Results

Women in the intervention group were more knowledgeable (mean score out of 10, 7.35 vs 6.27, p < 0.001) and were more likely to have made a decision (82% vs 61% p < 0.001). Of those who made a decision, women in the intervention group were less likely to start screening now (52% vs 65% p = 0.05). There was no significant difference in the proportion of women who made an informed choice (71% intervention group vs 64% control group, p = 0.24). The DA was helpful, balanced and clear, and did not make women anxious.

Conclusions

The DA increased knowledge and reduced indecision, without increasing feelings of anxiety.

Practice Implications

This decision aid is easy to access online and could be an inexpensive way of supporting women aged 40 who are considering whether to start screening now, or wait until they are 50. The results of this study demonstrate the potential of DAs to help inform women about both the benefits and risks of screening at this age and to support women and clinicians in this decision making process.     

A systematic review and meta-analysis of face-to-face communication of tailored health messages: implications for practice

Objective

To conduct a systematic review of the effect of face-to-face delivered tailored health messages on patient behavior and applications for practice.

Design

A systematic literature review and meta-analysis.

Methods

Systematic searches of a number of electronic databases were conducted and criteria for selection of studies were specified.

Results

6 experimental studies published between 2003 and 2009 were included. The studies were all randomized controlled trials to evaluate the effectiveness of a face-to-face tailored messaging intervention. There were variation in their research design and methods used to randomize. All participants were aged at least 18 years. All of the studies reported positive changes in participants’ health behavior with varying degrees of effect size and duration. A meta-analysis of the available data also confirmed an overall positive effect of tailored messaging on participants’ health behaviors.

Conclusion

The systematic review and the meta-analysis demonstrate a significant and positive effective of face-to-face tailored messaging upon participants’ health behaviors.

Practice implications

Health practitioners should be encouraged to allot time in their work routines to discover their patients’ psycho-social characteristics and felt needs in order that they can provide a tailored health message to enable the patient to adopt health-promoting regimes into their lifestyle.     

Health information seeking: a review of measures and methods

Objective

Outlines the methods and measures commonly used to study active health information seeking and prescribes important considerations in advancing the study of patient information seeking.

Methods

A systematic review of the literature from 1978 to 2010. A single bibliometric database, PsychInfo, identified 648 articles of health information seeking. The 129 articles included in the review were coded by type of sample, measures (n = 12) utilized to study health information seeking, and types of study methods (n = 5).

Results

A majority of studies used non-clinical samples and measured general health information seeking (i.e., whether the participant engaged in a search for health information) through cross-sectional study designs.

Conclusions

There are varying samples, measures, and designs used to identify those who do or do not seek health information. Future research should look into how health information seeking influences health management and should uncover the social and relational functions of health information seeking using more advanced (and less routinely applied) measures and methods of studying health information seeking.

Practice implications

More people are actively searching for health information and health providers should address this in their discussions with patients.     

Relationships and emotional wellbeing among African American and White advanced cancer caregivers

Objective

Advanced cancer family caregivers who have good relationships with other family members and with patient's health care providers (PHCPs) have less emotional distress than caregivers with poor relationships. Given a history of different experiences in medical settings among Whites and African Americans, we examined moderation effects by race.

Methods

Baseline data from an ongoing study were collected via telephone interviews with 397 family caregivers of advanced cancer patients at two cancer clinics. Depressed mood and anxiety were measured with the 14-item Profile of Mood States.

Results

Caregivers reporting good relationships with family (p < .001) and PHCPs (p < .001) had lower anxiety and less depressed mood (family, p < .01; PHCP, p < .001). Caregiver race moderated relationship quality: Whites with good PHCP relationships felt less depressed mood (p < .01) and anxiety (p < .01). African Americans with good family relationships showed less depressed mood (p < .05), but no association with anxiety.

Conclusion

Good relationships are important for caregivers, but PHCPs may have more influence on the wellbeing of White than of African American caregivers.

Practice implications

Developing relationships with caregivers of advanced cancer patients may improve wellbeing for caregivers. In addition, creating strategies to support family relationships may be a useful intervention, especially for African American advanced cancer caregivers.     

M-ficolin in children with cancer

Objectives

M-ficolin (ficolin-1) is a complement-activating pattern-recognition molecule structurally related to mannan-binding lectin. It is produced by monocytes and neutrophils, and is found in serum. Its biological role is largely unknown. We assessed M-ficolin concentration in serum from pediatric cancer patients. The aim of this study was to explore association of M-ficolin with clinical and hematological parameters, and to investigate whether the risk of chemotherapy-related infections was related to M-ficolin concentrations in serum.

Methods

M-ficolin was measured by time-resolved immunofluorometric assay in serum taken at cancer diagnosis and was correlated with peripheral blood counts and bone marrow examinations performed at the same time.

Results

Median M-ficolin concentration in 94 children with cancer was 1.6 μg/mL (interquartile range, 0.57-2.7; range, 0.055-25.8), and was not different from age-matched controls (median, 1.7 μg/mL; p = 0.92). M-ficolin was strongly associated with absolute counts of neutrophils (Spearman's rho, 0.45; 95%-CI, 0.26-0.65; p < 0.001), monocytes (0.34; 0.12-0.55; p < 0.001), and thus phagocytes (0.42; 0.20-0.63; p < 0.001) in peripheral blood. Similarly, M-ficolin correlated strongly with neutrophils (0.36; 0.14-0.59; p = 0.002) and phagocytes (0.31; 0.08-0.54; p = 0.009) in bone marrow. Low serum M-ficolin (≤0.5 μg/mL) was not associated with an increased incidence of fever in neutropenia during chemotherapy (multivariate Poisson rate ratio, 1.04; 95%-CI, 0.68-1.60; p = 0.85).

Conclusions

The concentration of M-ficolin in serum from children with cancer was strongly associated with neutrophil and monocyte counts in blood and bone marrow. These results suggest that M-ficolin concentrations in serum reflect the pool of phagocytes.     

Effectiveness of individual resource-oriented joint protection education in people with rheumatoid arthritis. A randomized controlled trial

Objective

The modern joint protection (JP) concept for people with rheumatoid arthritis (RA) is an active coping strategy to improve daily tasks and role performance by changing working methods and using assistive devices. Effective group JP education includes psycho-educational interventions. The Pictorial Representation of Illness and Self Measure (PRISM) is an interactive hands-on-tool, assessing (a) the individual's perceived burden of illness and (b) relevant individual resources. Both issues are important for intrinsic motivation to take action and change behaviour. This study compared individual conventional JP education (C-JP) with PRISM-based JP education (PRISM-JP).

Methods

An assessor-blinded multicentre randomized controlled trial, including four JP education sessions over 3 weeks, with assessments at baseline and 3 months.

Results

In total 53 RA patients participated. At 3 months, the PRISM-JP (n = 26) participants did significantly better compared to the C-JP participants (n = 27) in JP behaviour (p = 0.02 and p = 0.008 when corrected for baseline values), Arthritis Self-efficacy (ASES, p = 0.015) and JP self-efficacy (JP-SES, p = 0.047). Within-group analysis also showed less hand pain (p < 0.001) in PRISM-JP group.

Conclusion

PRISM-JP more effectively supported learning of JP methods, with meaningful occupations, resource activation and self-efficacy acting as important mediators.

Practice implications

PRISM improved patient-clinician communication and is feasible for occupational therapy.     

Association of age, health literacy, and medication management strategies with cardiovascular medication adherence

Objective

To examine patients’ use of medication management strategies (e.g., reminders, pill boxes), and to determine how their use influences the relationship between patient characteristics and medication adherence.

Methods

Retrospective and cross-sectional study of 434 patients with coronary heart disease, examining both refill adherence and self-reported adherence.

Results

The most common strategy for managing refills was seeing a near empty pill bottle (89.9%), and for managing daily medications, it was associating medications with daily events (80.4%). Age < 65 (OR = 1.7), as well as marginal (OR = 2.0) or inadequate health literacy (OR = 1.9), was independently associated with low refill adherence. Patients <65 also had lower self-reported adherence (OR = 1.8). Adjustment for use of medication management strategies did not substantially change these relationships. Reliance on reminders from friends or family to take medications, or waiting to refill a medicine only when the bottle was near empty, each were associated with 3-fold greater odds of non-adherence.

Conclusion

Age <65 and marginal or inadequate health literacy were independently associated with medication non-adherence. Use of medication management strategies did not explain these relationships.

Practice implications

The strategies which patients report using to assist with managing medication refills and daily medication use may be ineffective.     

Gender differences in a cohort study of 604 bipolar patients: the role of predominant polarity

Background

Some clinical differences between gender regarding the course and outcome of bipolar disorders have already been described and some others remain still controversial.

Aims

To explore gender differences regarding clinical and socio-demographic characteristics amongst bipolar patients with particular attention to predominant polarity and depressive symptoms.

Method

Data were collected from DSM-IV type I and II bipolar patients (n = 604), resulting from the systematic follow-up of the Bipolar Disorders Program, Hospital Clinic of Barcelona, over an average follow-up of 10 years. Socio-demographic and clinical variables were collected in order to detect gender-related differences.

Results

Bipolar women are more likely than men to show a predominance of depressive polarity as well as a depressive onset whilst men would be more likely to suffer from comorbid substance use disorders. Women significantly have a higher lifetime prevalence of psychotic depression and a higher prevalence of axis II comorbid disorders. Bipolar women are also more likely to have a family history of suicide and a lifetime history of attempted suicide. Suicide attempts are more often violent amongst bipolar men. In a backward logistic regression model, two variables were responsible for most gender-related clinical differences: type of predominant polarity - more likely to be depressive amongst women - (B = − 0.794, p = 0.027, Exp(B) = 0.452; CI =  0.223-0.915), alcohol abuse (B = − 1.095, p = 0.000, Exp(B) = 2990; CI =  1.817-4.919) and cocaine abuse (B = 0.784, p = 0.033, Exp(B) = 2.189; CI =  1.066-4.496) - more prevalent amongst men.

Conclusion

The main characteristic featuring bipolar women is depression, both at illness onset and as a predominant polarity all along the illness course. This may have important diagnostic and therapeutic implications.     

Serum amylase in bulimia nervosa and purging disorder: differentiating the association with binge eating versus purging behavior

Objective

Elevated serum amylase levels in bulimia nervosa (BN), associated with increased salivary gland size and self-induced vomiting in some patients, provide a possible marker of symptom severity. The goal of this study was to assess whether serum hyperamylasemia in BN is more closely associated with binge eating episodes involving consumption of large amounts of food or with purging behavior.

Method

Participants included women with BN (n = 26); women with “purging disorder” (PD), a subtype of EDNOS characterized by recurrent purging in the absence of objectively large binge eating episodes (n = 14); and healthy non-eating disorder female controls (n = 32). There were no significant differences in age or body mass index (BMI) across groups. The clinical groups reported similar frequency of self-induced vomiting behavior and were free of psychotropic medications. Serum samples were obtained after overnight fast and were assayed for alpha-amylase by enzymatic method.

Results

Serum amylase levels were significantly elevated in BN (60.7 ± 25.4 international units [IU]/liter, mean ± sd) in comparison to PD (44.7 ± 17.1 IU/L, p < .02) and to Controls (49.3 ± 15.8, p < .05).

Conclusion

These findings provide evidence to suggest that it is recurrent binge eating involving large amounts of food, rather than self-induced vomiting, which contributes to elevated serum amylase values in BN.     

Delayed sleep phase syndrome is related to seasonal affective disorder

Background

Both delayed sleep phase syndrome (DSPS) and seasonal affective disorder (SAD) may manifest similar delayed circadian phase problems. However, the relationships and co-morbidity between the two conditions have not been fully studied. The authors examined the comorbidity between DSPS and SAD.

Methods

We recruited a case series of 327 DSPS and 331 controls with normal sleep, roughly matched for age, gender, and ancestry. Both DSPS and controls completed extensive questionnaires about sleep, the morningness-eveningness trait, depression, mania, seasonality of symptoms, etc.

Results

The prevalences of SAD and subsyndromal SAD (S-SAD) were higher in DSPS compared to controls (χ² = 12.65, p = 0.002). DSPS were 3.3 times more likely to report SAD (odds ratio, 3.34; 95% CI, 1.41-7.93) compared to controls as defined by the Seasonal Pattern Assessment Questionnaire (SPAQ). Correspondingly, DSPS showed significantly higher seasonality scores compared to controls in mood, appetite, and energy level subscores and the global seasonality score (t = 3.12, t = 0.002; t = 2.04, p = 0.041; t = 2.64, p = 0.008; and t = 2.15, p = 0.032, respectively). Weight fluctuation during seasons and winter-summer sleep length differences were also significantly higher in DSPS than controls (t = 5.16, p < 0.001 and t = 2.64, p = 0.009, respectively). SAD and S-SAD reported significantly higher eveningness, higher depression self-ratings, and more previous mania symptoms compared to non-seasonal subjects regardless of whether they were DSPS or controls.

Conclusions

These cases suggested that DSPS is partially comorbid with SAD. These data support the hypothesis that DSPS and SAD may share a pathophysiological mechanism causing delayed circadian phase.     

Self-efficacy as a predictor of improvement in health status and overall quality of life in pulmonary rehabilitation—An exploratory study

Objective

To evaluate developments in health status (HS) and overall quality of life (QOL), and the impact of self-efficacy on HS and QOL in relation to COPD pulmonary rehabilitation (PR).

Methods

A longitudinal study of 100 COPD patients before and up to 3 months after COPD PR. Self-efficacy was measured by the COPD self-efficacy scale, HS by the St. George Respiratory Questionnaire and QOL by the Quality of Life Scale. Mixed effect models were used.

Results

Patients reported significantly reduced psychosocial impact of disease (estimate = −4.05, p = 0.019) immediately after the PR programme. Higher levels of self-efficacy at baseline predicted significantly reduced psychosocial impact of disease and improved physical activity, total HS and QOL (p < 0.05). Better exercise capacity at baseline predicted significantly reduced psychosocial impact of disease, improved physical activity and QOL (p < 0.05). Older age at baseline predicted significantly fewer respiratory symptoms and improved total HS (p < 0.05).

Conclusions

Patients reported significantly reduced psychosocial impact of disease immediately after a COPD PR, and better exercise capacity and higher self-efficacy at baseline predicted significantly improved HS and QOL.

Practice implications

Increasing self-efficacy is suggested to be an important aim in relation to COPD PR.     

Effects of video-based, online education on behavioral and knowledge outcomes in sunscreen use: A randomized controlled trial

Objectives

To compare online video and pamphlet education at improving patient comprehension and adherence to sunscreen use, and to assess patient satisfaction with the two educational approaches.

Methods

In a randomized controlled trial, 94 participants received either online, video-based education or pamphlet-based education that described the importance and proper use of sunscreen. Sun protective knowledge and sunscreen application behaviors were assessed at baseline and 12 weeks after group-specific intervention.

Results

Participants in both groups had similar levels of baseline sunscreen knowledge. Post-study analysis revealed significantly greater improvement in the knowledge scores from video group members compared to the pamphlet group (p = 0.003). More importantly, video group participants reported greater sunscreen adherence (p < 0.001). Finally, the video group rated their education vehicle more useful and appealing than the pamphlet group (p < 0.001), and video group participants referred to the video more frequently (p = 0.018).

Conclusion

Video-based learning is a more effective educational tool for teaching sun protective knowledge and encouraging sunscreen use than written materials.

Practice implications

More effective patient educational methods to encourage sun protection activities, such as regular sunscreen use, have the potential to increase awareness and foster positive, preventative health behaviors against skin cancers.     

Patient education in groups increases knowledge of osteoporosis and adherence to treatment: A two-year randomized controlled trial

Objective

Non-adherence to pharmacological treatment in osteoporosis is a well-recognized problem. We hypothesized that a group-based educational programme would increase patients’ knowledge and level of adherence with medical treatment.

Methods

A total of 300 patients (32 men aged 65 ± 9 years and 268 women aged 63 ± 8 years), recently diagnosed with osteoporosis, were randomised to either an osteoporosis school programme (four classes of 8-12 participants over four weeks) or a control group. Teaching was multidisciplinary, based on patients’ experiences and background and designed to encourage empowerment. Patients’ knowledge about osteoporosis and adherence to treatment was assessed with self-completed questionnaires at baseline and after 3, 12, and 24 months.

Results

There were no significant differences at baseline between the two groups with respect to knowledge score or level of adherence. At two years’ follow-up, the improvement in knowledge score was 2 [0-4] points (median [25-75 percentiles]) in the school group and 0 [−2 to 2] in controls (p < 0.001) and self-reported adherence to pharmacological therapy was significantly higher in the school group (92%) compared to the control group (80%), p < 0.001.

Conclusion

The programme increased knowledge about osteoporosis and increased self-reported adherence to pharmacological treatment over a period of two years.     

Allelic variations in superoxide dismutase-1 (SOD1) gene are associated with increased risk of diabetic nephropathy in type 1 diabetic subjects

Background

Oxidative stress is involved in the pathophysiology of diabetic nephropathy. The superoxide dismutase (SOD) enzymes play a major role in detoxification of reactive oxygen species and have a protective effect against diabetic nephropathy. We investigated associations of allelic variations in SOD1 gene with nephropathy in patients with type 1 diabetes.

Methods

Seven SNPs in SOD1 region were analyzed in 1285 type 1 European Caucasian diabetic patients from the SURGENE prospective study (n = 340; ten year follow-up), and the Genesis France-Belgium (n = 501) and GENEDIAB (n = 444) cross-sectional studies. Cox proportional hazards and logistic regression analyses were used to estimate hazard ratios or odds ratios for incidence and prevalence of diabetic nephropathy.

Results

In the SURGENE study, the T-allele of rs1041740 was associated with the prevalence of incipient (OR 5.75, 95% CI 1.78-19.39, p = 0.004) and established/advanced nephropathy at baseline (OR 8.95, 95% CI 1.51-58.42, p = 0.02), and with the incidence of incipient nephropathy during follow-up (HR 1.46, 95% C.I. 1.13-1.90, p = 0.004). The variant was also associated with decreased estimated glomerular filtration rate (eGFR) throughout the study. In cross-sectional study of Genesis/GENEDIAB cohorts, the G-allele of rs17880135 was associated with incipient (OR 7.53, 95% CI 2.30-25.45, p = 0.001), established (OR 6.04, 95% CI 1.52-23.91, p = 0.01) and advanced nephropathy (OR 10.03, 95% CI 2.95-35.44, p = 0.0003).

Conclusions

SOD1 allelic variations were associated with the prevalence of diabetic nephropathy, with the incidence of microalbuminuria and with decreased eGFR in type 1 diabetic subjects. These results are consistent with an implication of oxidative stress in the pathophysiology of diabetic nephropathy and with the major role for antioxidant enzymes as a mechanism of renal protection.